Dealing with spinal cord injuries

Friday

Mar 8, 2013 at 4:26 PMMar 8, 2013 at 4:32 PM

“Sports accidents, motor vehicle crashes, and falls are among the most common reasons that people experience spinal cord injuries,” according to Lawrence Maccree, a board-certified neurosurgeon on the staff of Methodist Medical Center of Oak Ridge.

"Sports accidents, motor vehicle crashes, and falls are among the most common reasons that people experience spinal cord injuries," according to Lawrence Maccree, a board-certified neurosurgeon on the staff of Methodist Medical Center of Oak Ridge.

"Serious injuries can occur in any part of the spine or to nerves at the end of the spine, resulting in permanent problems in sensation, strength, and other bodily functions below the injured area," he explained.

Maccree offers some timely information that may help people prevent injuries or deal with situations when back and neck injuries occur.

Prevention

"Spinal cord injuries (SCI) have a primary and secondary component to them," he said. "When a SCI happens, the primary component occurs at the time of injury. Unfortunately there is little that can be done for the primary injury other than supportive care. The secondary portion of SCI is preventable and involves what happens to the patient after the accident. Secondary injuries often involve getting appropriate oxygen and blood supply to the area, as re-injury can occur when an unstable area is moved without proper care or support."

Accidents that cause SCI are often preventable. For example, when someone participates in activities that are commonplace — as well as those that have a higher risk of injury — taking precautions could prevent SCI altogether or lessen the secondary damage.

Such precautions might include the following:

Vehicle crashes

"Automobile crashes are one of the most common causes of spinal cord injuries," Maccree said. "Wearing a seatbelt every time you drive or ride in a car is the easiest way of preventing SCI. Make sure that children wear a seat belt or use an age- and weight-appropriate child safety seat, and that children under age 12 always ride in the back seat. Do not drink and drive, and never ride with a driver who is drunk or under the influence of certain mind-altering drugs."

Sports injuries

Sports injuries are a rising cause of SCIs, he noted. "It is always smart to wear recommended sports safety gear when you play contact sports, ski or go snowboarding, and to maintain the gear appropriately. Never do potentially dangerous activities alone. When skiing or snowboarding, stay on appropriate, marked trails, and use hills that are within your skill levels. When you start feeling too tired, get off the slopes."

Falling

To reduce your risk of falling, Maccree recommends using a step stool with a grab bar to reach objects in high places. Install handrails along stairways, nonslip mats on tile floors and in the tub or shower, and safety gates, as needed, when children are in your home.

"Many of the most common reasons for falls are preventable," he emphasized.

Symptoms of a spinal cord injury include:

• Extreme back pain or pressure in the neck, head or back

• Weakness or paralysis in any part of your body

• Loss of sensation or tingling in your hands, fingers, feet or toes

• Loss of bladder or bowel control

• Difficulty with balance and walking

• Difficulty breathing

• A twisted neck or back

"Keep in mind that symptoms may develop slowly as swelling or bleeding occurs around the spinal cord. Calling 911 and obtaining emergency medical care as soon as symptoms develop can be critically important," Maccree emphasized.

Emergency care

If you suspect that someone has a back or neck injury, Maccree advises the following:

• Call 911.

• Do not move the injured person or let the person move because movement may cause permanent paralysis and other serious complications.

• Place heavy towels on both sides of the neck. If you cannot find towels, hold the person's head and neck to prevent them from moving until emergency care arrives.

• Stop any bleeding and make the person comfortable if you can do so without moving the head or neck.

Diagnosis

In the emergency room, a doctor may rule out a spinal cord injury by carefully examining the patient, testing sensory function and movement, and asking questions about the accident, Maccree stated.

If the patient has obvious signs of a neurological injury or cannot respond, the doctor may order emergency diagnostic tests. These tests may include X-rays to detect abnormalities of the spinal column, CT scans to better examine abnormalities found on an X-ray, or an MRI to help the doctor identify herniated disks, blood clots, or other masses that may be compressing the spinal column. In the case of complete spinal cord injury, nothing may be able to reverse the problem. Within a few days, some of the swelling should subside, and the doctor can conduct a neurological exam to better determine the level and completeness of the injury.

Treatment

Treatment for spinal cord injuries often begins at the scene of the accident. Emergency personnel immobilize the spine before transporting the patient to the hospital. At the hospital, emergency room doctors may work to maintain the patient's ability to breathe, to prevent shock, to prevent complications involving the bladder, lungs and heart, and to prevent deep vein blood clots from developing. Once they are stabilized, patients are typically admitted to the intensive care unit.

"Surgery is often needed to remove bone fragments and repair herniated disks or fractured vertebrae that may be compressing the spinal cord," Maccree added. "The length of a person's hospitalization following surgery varies, depending on that patient's specific situation."

Rehabilitation, use of medications and other treatments may be necessary when the patient leaves the hospital.

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About the Featured Physician: Lawrence Maccree is a board-certified neurosurgeon on the staff of Methodist Medical Center of Oak Ridge. He is a graduate of Western University of Health Sciences, College of Osteopathic Medicine in Pomona, Calif. Maccree completed neurosurgery residencies at the Garden City Osteopathic Hospital in Garden City, Mich. He also completed an undergraduate teaching fellowship at Western University of Health Sciences, College of Osteopathic Medicine.

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